摘要
目的 探讨不同麻醉方法对胃癌患者围术期T淋巴细胞亚群的影响。方法 36例择期胃癌根治术患者 ,随机分为硬膜外阻滞组 (Ⅰ组 )、全麻组 (Ⅱ组 )和硬膜外阻滞复合全麻组 (Ⅲ组 ) ,每组 12例 ,分别于诱导前、术毕及术后 1、3、5、7d取外周静脉血 2ml,采用APAAP法测定T淋巴细胞亚群的变化。结果 与诱导前相比 ,术毕、术后第 1、3d ,各组CD+ 3 、CD+ 4 、CD+ 8及CD+ 4 /CD+ 8均明显下降 (P <0 0 5 ) ;术后第 5d ,Ⅲ组各指标恢复 (P >0 0 5 ) ;术后第 7d ,Ⅰ、Ⅱ组各指标恢复 (P >0 0 5 )。Ⅲ组CD+ 3 、CD+ 4 及CD+ 4 /CD+ 8于术后第 5d明显高于Ⅰ、Ⅱ组 (P <0 0 5 )。结论 硬膜外复合全麻能减轻围术期应激反应及麻醉药物对T淋巴细胞亚群的抑制 ,有利于胸腹部肿瘤病人免疫功能的及早恢复。
Objective To determine the effects of different anesthetic techniques on T lymphocyte subsets in patients undergoing radical gastric cancer operation, trying to find an anesthetic technique causing least immunodepression for this type of surgery Methods Thirty six ASA Ⅰ Ⅱ patients undergoing elective radical operation for gastric cancer, age between 40 60 years and body weight 50 80 kg, the patients were randomly assigned to one of three groups, group Ⅰ: epidural anesthesia; group Ⅱ: general anesthesia; group Ⅲ: epidural anesthesia combined with general anesthesia(n=12 in each group) The patients were premedicated with intramuscular luminal sodium 0 1 g and atropine 0 5 mg In group Ⅰ patients received an epidural catheter at T 7 8 or T 8 9 and block was carried out by 1 5% lidocaine mixed with 0 25% pontocaine (6:2 solution) The loading dose was 10 15 ml During the operation the patients were sedated with pethidine ,fentanyl or diazepam In group Ⅱ general anesthesia was induced with fentanyl 0 1 0 2mg, droperidol 2 5 5 0 mg and etomidate 0 2 0 3mg/kg Intubation was facilitated with succinylcholine 100 mg Anesthesia was maintained with continuous infusion of propofol and inhalation of enflurane Peripheral blood samples were taken before induction, at the end of operation and on 1st, 3rd,5th and 7th postoperative day for detrmination of CD + 3, CD + 4, CD + 8 and CD + 4/CD + 8 values by APAAP method Results There were no significant differences in age, body weight, ASA class, and surgical duration between the 3 groups CD + 3, CD + 4, CD + 8 and CD + 4/CD + 8 decreased significantly at the end of operation and on the 1st and 3rd postoperative day in all groups (P<0 05) In group Ⅲ CD + 3, CD + 4, CD + 8 and CD + 4/CD + 8 almost returned to baseline values on the 5th postoperative day In group Ⅰ and Ⅱ CD + 3, CD + 4, CD + 8 and CD + 4/CD + 8 were close to baseline values on the 7th postoperative day On the 5th postoperative day CD + 3,CD + 4 and CD + 4/CD + 8 were significantly higher in group Ⅲ than those in group Ⅰ and Ⅱ (P<0 05) Conclusions Epidural anesthesia combined with general anesthesia can reduce depression of T lymphocyte subsets induced by surgical trauma and anesthesia, and is the anesthetic tecnique of choice for cancer patients undergoing major operation
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第4期220-222,共3页
Chinese Journal of Anesthesiology
